Next screenplay's MC is a surgeon, questions about a surgical resident's day

[DarnellWeeks]

Few things: My screenname and email address aren't real. Privacy concerns and what not but more importantly my word of not saying anything until it is done.

Essentially it is this: I'm writing a screenplay that half or most of the first act of it is going to be one shift for a surgical resident. I'm visiting a hospital later this next week for good ol' fashioned first-person research and might even get to shadow a neurosurgeon resident. With that said: I can't wait until later this week to start writing. The ideas from the subconscious are flowing and it's taking every fiber of my muscles to physically restrain my muscles from opening up Final Draft and starting this. But if it can't be authentic then it is bull****. So google led me here.

The main character is a head of his class surgical resident. His arrogance is absolute but actually backed up by skill and talent. He has not an ounce of a Messiah complex.

So the questions are:

This guy: what type of hospital would this guy be working at? Something like the Mayo clinic? If he's from the Ivy Leagues would that change it?

Does he work in a team beneath the actual/main/pardon my complete ignorance of the actual term surgeon? Or does he work in a revolving team beneath many surgeons?

Does he get to do rounds? Are they alone or with those in his team?

Does he get a vacation? How long? If not and he left on a vacation without telling anyone for a three-day weekend would he not have a job upon coming back?

How many surgeries would he be observing/participating in a day? What's a timeline for when he wakes up each morning to when he gets off the clock?

I'm planning on him being in the neurosurgery line. Unless there's some sort of jack of all trades field. Anyways, in a surgery, how often does an artery get accidentally snipped? Is that too cliched of a Hollywood device for botches in a surgery? What SHOULD an accident be, if there is one? And if there is one... what would happen to this guy? When the main surgeon looks over it to assess the damage, would the guy get to continue or would he get taken off? Is it case by case?

Any help on this would be greatly, greatly appreciated.

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[Castro Viejo]

The main character is a head of his class surgical resident. His arrogance is absolute but actually backed up by skill and talent. He has not an ounce of a Messiah complex.

So the questions are:

This guy: what type of hospital would this guy be working at? Something like the Mayo clinic? If he's from the Ivy Leagues would that change it?

Could be Mayo Clinic. Could be Cleveland Clinic. Any of the bigger named hospitals in the Northeast associated with an Ivy League medical school would fit the bill as well I suppose. In the South? Try Baylor. On the West Coast? UCSF, Stanford, UCLA would all be pretty up there. The Midwest? Northwestern, University of Chicago, and University of Michigan are tops.

I suppose it depends more on where this show is set. There are very well known hospitals all over the country.

Does he work in a team beneath the actual/main/pardon my complete ignorance of the actual term surgeon? Or does he work in a revolving team beneath many surgeons?

It depends on this person's level of training. An intern (i.e., first-year resident) is the bottom of the barrel made to do the most menial of tasks. Junior level residents (interns to second or third-year residents) take on more responsibility for patient care and operating as they advance. Senior level residents beyond the fourth year usually begin to lead teams of junior residents on their own. Their decisions for patient care are typically reviewed by an attending surgeon or staff surgeon, what you referred to as the "main" surgeon. The Chief Resident is in his final year of training and bears ultimate responsibility for what the team of residents do within the hospital. In some institutions he will also take the lead as the surgeon in the operating room with supervision by an attending or staff surgeon.

Does he get to do rounds? Are they alone or with those in his team?

At the appropriate level, yes, he would lead rounds.

Typically the teams they lead (sometimes referred to as "services") will be composed of a number of junior level residents and, if he's a Chief Resident, a senior resident as well.

Does he get a vacation? How long? If not and he left on a vacation without telling anyone for a three-day weekend would he not have a job upon coming back?

Vacation is built into most residency training programs. Somewhere between 3 and 4 weeks are typically allowed.

Three day weekends? Almost unheard of, but possible if the schedule permits. There's always someone who's in the hospital though, so if this guy was really as bad-*** as you describe, he probably wouldn't abandon the hospital without ensuring adequate coverage no matter how great he thinks he is.

How many surgeries would he be observing/participating in a day? What's a timeline for when he wakes up each morning to when he gets off the clock?

Depends on the service and the specialty. You say Neurosurgery? Hmmm... The public's fascination with "Brain Surgeons" will never cease to amaze me. It's not very dramatic in my opinion, but I suppose it does have that awe factor for the lay public.

Timeline would be somewhere around waking up at 4AM to get to work by 5AM to round and get to the OR by 7:30AM. Depending on his level of training he'll either be in the OR all day (seniors and Chief Residents) or on the wards taking care of patients (juniors).

I'm planning on him being in the neurosurgery line. Unless there's some sort of jack of all trades field.

Jack of all Trades = "General Surgery."

Anyways, in a surgery, how often does an artery get accidentally snipped? Is that too cliched of a Hollywood device for botches in a surgery? What SHOULD an accident be, if there is one? And if there is one... what would happen to this guy? When the main surgeon looks over it to assess the damage, would the guy get to continue or would he get taken off? Is it case by case?

An artery gets snipped all the time. The question is whether or not it needed to be (in the case of taking something out, the arterial supply has to be sacrificed to remove something). If it didn't need to be and the artery was snipped, depending on what artery it was, it could be not such a big deal to a big, big deal.

An accident? Depends on the operation. The typical Hollywood thing would be uncontrolled bleeding and the surgeon has no idea what the hell to do, and in steps someone ordained with the hands of God, who flips one thing over, twists another thing, and voila, bleeding stops. I think I saw that on the first episode of Grey's Anatomy. By the way, I personally think it's a pretty stupid show from a surgical perspective, but I'd watch it more for the drama and Katherine Heigl.

Good luck to you.

 

[Winged Scapula]

Does he really have to be arrogant?

This is such a cliche and unfortunately, the public buys into it and assumes that all surgeons are arrogant. This assumption affects our daily lives in and out of the operating room because a simple request or action is seen as being product of our presumed superiorty complex.

How about the hard-working, humble surgery resident who put himself through medical school (please show how much his student loans weigh on him) and while possessing a black sense of humor, maintains his pleasant personality?

At any rate, there isn't much to add to what Castro has mentioned.

Vacations are generally a week in length, scheduled far in advance and most residents don't make enough to travel to some exotic locale. So please don't show him kicking it in Tahiti during his vacation.

As for leaving for a vacation, even a 3 day weekend, without telling anyone, there would generally be hell to pay when he returned. Whether or not he would be fired would depend on his level, his performance to that point and a certain amount of contrition on his part.

You can call him Dr. Cox if you like.

 

[DarnellWeeks]

Could be Mayo Clinic. Could be Cleveland Clinic. Any of the bigger named hospitals in the Northeast associated with an Ivy League medical school would fit the bill as well I suppose. In the South? Try Baylor. On the West Coast? UCSF, Stanford, UCLA would all be pretty up there. The Midwest? Northwestern, University of Chicago, and University of Michigan are tops.

I suppose it depends more on where this show is set. There are very well known hospitals all over the country.

Thank you.

It depends on this person's level of training. An intern (i.e., first-year resident) is the bottom of the barrel made to do the most menial of tasks. Junior level residents (interns to second or third-year residents) take on more responsibility for patient care and operating as they advance. Senior level residents beyond the fourth year usually begin to lead teams of junior residents on their own. Their decisions for patient care are typically reviewed by an attending surgeon or staff surgeon, what you referred to as the "main" surgeon. The Chief Resident is in his final year of training and bears ultimate responsibility for what the team of residents do within the hospital. In some institutions he will also take the lead as the surgeon in the operating room with supervision by an attending or staff surgeon.

If this character is 28ish, what level would you expect him to be?

At the appropriate level, yes, he would lead rounds.

I'm assuming a typical round for one patient involves looking at the heart monitor for whatever it is you guys look for, monitoring pain levels, and asking the same questions as the days before to make sure the patient isn't getting worse?

Typically the teams they lead (sometimes referred to as "services") will be composed of a number of junior level residents and, if he's a Chief Resident, a senior resident as well.

Thank you very much.

Vacation is built into most residency training programs. Somewhere between 3 and 4 weeks are typically allowed.

This is probably going to sound like a ridiculously stupid question, but is that for the overall length of the residency or for one calendar year?

Three day weekends? Almost unheard of, but possible if the schedule permits. There's always someone who's in the hospital though, so if this guy was really as bad-*** as you describe, he probably wouldn't abandon the hospital without ensuring adequate coverage no matter how great he thinks he is.

Would he have a job if he came back from an unannounced three day weekend?

Depends on the service and the specialty. You say Neurosurgery? Hmmm... The public's fascination with "Brain Surgeons" will never cease to amaze me.

It doesn't have to be neurosurgery. I would almost prefer if it wasn't. I don't even have to explicitly state which field he's in. But, yeah, I'd say at large it's the 'brain' part of 'brain surgeon' that brings in the appeal.

It's not very dramatic in my opinion, but I suppose it does have that awe factor for the lay public.

What is dramatic in your opinion? What do you and your cronies find dramatic?

Timeline would be somewhere around waking up at 4AM to get to work by 5AM to round and get to the OR by 7:30AM. Depending on his level of training he'll either be in the OR all day (seniors and Chief Residents) or on the wards taking care of patients (juniors).

If he's in the OR all day, is he observing/doing and washing in and out for surgeries all day? Excuse my ignorance. If he's in the wards all day, what does that entail? Going around with a stethoscope?

Jack of all Trades = "General Surgery."

How high on the ladder is that viewed as?

An artery gets snipped all the time. The question is whether or not it needed to be (in the case of taking something out, the arterial supply has to be sacrificed to remove something). If it didn't need to be and the artery was snipped, depending on what artery it was, it could be not such a big deal to a big, big deal.

Fair enough.

An accident? Depends on the operation. The typical Hollywood thing would be uncontrolled bleeding and the surgeon has no idea what the hell to do, and in steps someone ordained with the hands of God, who flips one thing over, twists another thing, and voila, bleeding stops.

It would be nothing like that. I'm still undecided if an accident needs to happen or not, but if it did, it's either the main character fixing what he ****ed up or the patient'll die.

I think I saw that on the first episode of Grey's Anatomy.

Hate that show.

By the way, I personally think it's a pretty stupid show from a surgical perspective, but I'd watch it more for the drama and Katherine Heigl.

She does have fantastic knockers.

Good luck to you.

Thank you.

 

[DarnellWeeks]

Does he really have to be arrogant?

This is such a cliche and unfortunately, the public buys into it and assumes that all surgeons are arrogant. This assumption affects our daily lives in and out of the operating room because a simple request or action is seen as being product of our presumed superiorty complex.

I may have been too strong with outright arrogance, but this is a character who is going to be ALWAYS right and he's going to be smart enough to know he's always right. He's not going to be dismissive a la Gregory House but he isn't going to bend over backwards trying to appease everyone. With that said, I doubt he'll be old enough to be a Chief or Senior resident. Anyways, I'm going to explore what happens to his psyche when he's wrong. I try not to make characters caricatures.

How about the hard-working, humble surgery resident who put himself through medical school (please show how much his student loans weigh on him)

This brings up a great question. How big of student loans would a 28 year old whatever average level or in a special case a level above have?

and while possessing a black sense of humor, maintains his pleasant personality?

He put himself through medical school, if that helps.

Vacations are generally a week in length, scheduled far in advance and most residents don't make enough to travel to some exotic locale. So please don't show him kicking it in Tahiti during his vacation.

/scratches the scene of him doing cocaine off of a Thai hooker

As for leaving for a vacation, even a 3 day weekend, without telling anyone, there would generally be hell to pay when he returned. Whether or not he would be fired would depend on his level, his performance to that point and a certain amount of contrition on his part.

Thank you.

You can call him Dr. Cox if you like.

Scrubs, right? I can't stand Zach Braff in that... but I enjoyed Garden State, even if it was a wee bit sentimental and had one of the most ridiculously pretentious scenes in history--that screaming into the abyss part.

 

[nonesuchgirl]

How about the hard-working, humble surgery resident who put himself through medical school (please show how much his student loans weigh on him) and while possessing a black sense of humor, maintains his pleasant personality?

You can call him Dr. Cox if you like.

I was going to ask if you were talking about Blade or Castro, but I guess I got my answer, gendered pronouns aside...

P)

 

[Bitsy3221]

If you peruse some of the other message boards on this site you can find some great insight, as there are a lot of residents and attendings offering advice to med students, which you might find helpful. There is a recent thread about which is the goriest specialty, which you may find interesting in regards to the "drama" factor.

If he is 28, he'd likely be a junior to midlevel resident (intern or second year). As far as loans, if you are talking about someone who went to an Ivy League school $200,000+ is a perfectly acceptable number. Please also bear in mind that residents only make in the $40-50,000/yr (depends on the geographic area & level of training, but even the most senior residents at the urban training centers will generally not make over $60,000/yr) so please don't portray the "rich doctor" thing just yet. "Putting oneself through medical school" is very hard to do, as most med students do not hold down additional jobs--the job of being a med student is time consuming enough.

There are several ways to portray morning rounds, at it varies from place to place and service to service. It also will depend on how sick a patient is--we don't round on ICU pts the same way we do for those on the floor. I train at a pretty old-school place, and have never been on rounds as formal as they portray them on Grey's Anatomy. We don't generally walk into a patient's room, ignore the pt, and present their entire history to the attending (a surgeon done with his training). Usually, the team consists of an intern or two, maybe a midlevel resident and then a senior/chief resident. Often a med student is there as well. We look at the vitals from the past 24 hrs, then enter the room. The most senior resident usually does the talking, while the more junior residents do the dressing changes and the physical exam.

As far as the unannounced weekend, that is honestly so far outside the realm of comprehension--I just can't imagine any hot-shot, top of the class resident doing this. I have only seen that happen once where I went to med school and that was b/c the guy was in jail (and yes, he got fired, but that is a much longer story for a much different time)

In terms of "high on the ladder," I don't think that is a fair question to ask, and is completely unanswerable. Just a quick perusal of these boards, and you will realize that surgeons (really, a doctor of any specialty) are very proud of their field. We all do very different things, and to be perfectly honest, most probably feel their job is the "hardest," but in the long run, we all do very hard work and we all have a vital role in the workings of the hospital. Depends on what you are looking to portray. Difficulty can strike any case in any specialty, but the areas where things can go south in a hurry include trauma, transplant, vascular, cardiac (off the top of my head). Throw in something involving a kid and the stakes (and stress) increases.

But realistically, most interns and junior residents in the OR are not doing the difficult or life-and-death cases. If they are, there are four other people scrubbed in ahead of them and they are not touching ANYTHING. If something critical happened, they are likely not going to be able to fix it either.

 

[Castro Viejo]

If this character is 28ish, what level would you expect him to be?

The average age of a medical school graduate in the United States is 26-27, making your man an intern or a second-year resident. No matter how good he believes himself to be, brain wise or technically, pretty much everyone will pounce on him for being a precocious intern. Surgery and all its wonderful subspecialties is a very hierarchical work environment and career. The nonsense portrayed on Grey's Anatomy, with interns sleeping with their attending/staff surgeons (though, on occasion, I've heard of that happening), Chief Residents addressing the Chairman of the Department of Surgery by his first name makes my skin crawl some time.

I'm assuming a typical round for one patient involves looking at the heart monitor for whatever it is you guys look for, monitoring pain levels, and asking the same questions as the days before to make sure the patient isn't getting worse?

"Rounds" is medicalese for reviewing all the patients on one's service. In the morning residents have "work rounds" that typically begin between 5AM and 6AM depending on the institution and the service. These are rounds lead by a Senior or Chief Resident where the junior resident presents significant events of each patient's last 12-24 hours of hospital time, typically at the bedside. The purpose of work rounds is for the Chief or Senior Resident to exercise his clinical decision making capacity and to draw up a preliminary plan, which the juniors typically follow (God willing) during the day (e.g., what blood work to order, what studies, consultations from other services, etc.). Following this, depending on the institution again, there are "attending rounds," "staff rounds," or "service rounds," where the entire service or team meets with the attending/staff surgeon and the senior or Chief Resident reviews his preliminary plan for the attending/staff surgeon's stamp of approval. They will alter the plan as they see fit, sometimes berating the Chief or Senior Resident in the process in the "Surgical Socratic Method."

But, yes, if the patient's on a monitor we'll review the monitor's data, the bedside "flowsheet" (a nurse's recordings of the patient's temperature curve, fluid intake, fluid output, blood pressure, heart rate, etc.).

This is probably going to sound like a ridiculously stupid question, but is that for the overall length of the residency or for one calendar year?

One academic year which begins July 1st and ends June 30th of the following year.

Would he have a job if he came back from an unannounced three day weekend?

As Winged Scapula noted, it depends on the resident and the Chairman. If the resident is not well liked (he's academically poor, technically a blob in the OR), then he might just get $hit-canned right then and there on showing up for work on Monday. If he's well liked, sometimes things are overlooked and the resident can almost get away with murder. Typically taking off without telling anyone can result in a major tongue lashing.

It doesn't have to be neurosurgery. I would almost prefer if it wasn't. I don't even have to explicitly state which field he's in. But, yeah, I'd say at large it's the 'brain' part of 'brain surgeon' that brings in the appeal.

What is dramatic in your opinion? What do you and your cronies find dramatic?

Dramatic? Heart Surgery. Trauma Surgery. Transplant Surgery. If it's done right these are ultra sexy and I think the public has a healthy fascination for some of this stuff.

If he's in the OR all day, is he observing/doing and washing in and out for surgeries all day? Excuse my ignorance. If he's in the wards all day, what does that entail? Going around with a stethoscope?

In the OR all day would be assisting on several operations through the course of the day.

Being on the wards means executing the Chief or Senior Resident's plan for each patient on the service with the attending/staff surgeon's changes, within a set timeframe before the Chief or Senior Resident come out of the OR and are ready for evening rounds.

Stethoscope? Hmmm... I'm a little conflicted about this. Surgeons don't typically carry around a stethoscope the way you see it done on "ER" or "Grey's Anatomy," hanging from one's neck. We see that typically only with non surgeon physicians, such as internists (internal medicine physicians), pediatricians, and ER physicians. The derogatory term bounced around amongst surgeons for such neck wearing stethoscoped physicians is "flea collar." We keep ours in our pockets if we carry one at all.

How high on the ladder is that viewed as?

General Surgery? In the grand hierarchy of things? I suppose in this day and age, General Surgery is the Jack of All Trades but Master of None. Most General Surgeons undergo additional training to become Heart Surgeons, Transplant Surgeons, Trauma Surgeons, Vascular Surgeons, Oncological Surgeons, etc.

I think General Surgery would just give you a little more flexibility in terms of what your character can do in the hospital, and not just the brain, or not just the heart, or not just the neck, etc.

 

[DarnellWeeks]

If you peruse some of the other message boards on this site you can find some great insight, as there are a lot of residents and attendings offering advice to med students, which you might find helpful. There is a recent thread about which is the goriest specialty, which you may find interesting in regards to the "drama" factor.

It's how I plan on spending the next hour.

If he is 28, he'd likely be a junior to midlevel resident (intern or second year). As far as loans, if you are talking about someone who went to an Ivy League school $200,000+ is a perfectly acceptable number. Please also bear in mind that residents only make in the $40-50,000/yr (depends on the geographic area & level of training, but even the most senior residents at the urban training centers will generally not make over $60,000/yr) so please don't portray the "rich doctor" thing just yet.

He is most certainly not rich.

"Putting oneself through medical school" is very hard to do, as most med students do not hold down additional jobs--the job of being a med student is time consuming enough.

When someone who's going to go down the surgery road is 22 and about done with the typical 120 credit thing... what is that person doing? I have a friend who is going to be a nurse. She's that age and just finished her clinicals and works at a hospital A LOT. What would my character be doing at this age? How often would he get to go out at that age? Is it conceivable to take a summer off after the four years and not do anything?

There are several ways to portray morning rounds, at it varies from place to place and service to service. It also will depend on how sick a patient is--we don't round on ICU pts the same way we do for those on the floor. I train at a pretty old-school place, and have never been on rounds as formal as they portray them on Grey's Anatomy. We don't generally walk into a patient's room, ignore the pt, and present their entire history to the attending (a surgeon done with his training). Usually, the team consists of an intern or two, maybe a midlevel resident and then a senior/chief resident. Often a med student is there as well. We look at the vitals from the past 24 hrs, then enter the room. The most senior resident usually does the talking, while the more junior residents do the dressing changes and the physical exam.

This helps a lot. Would a junior/midlevel ever get one on one time with a patient?

As far as the unannounced weekend, that is honestly so far outside the realm of comprehension--I just can't imagine any hot-shot, top of the class resident doing this.

Something is going to happen that makes him need to get away.

I have only seen that happen once where I went to med school and that was b/c the guy was in jail (and yes, he got fired, but that is a much longer story for a much different time)

Ouch.

In terms of "high on the ladder," I don't think that is a fair question to ask, and is completely unanswerable. Just a quick perusal of these boards, and you will realize that surgeons (really, a doctor of any specialty) are very proud of their field.

As well they should be; they do important work. Mea culpa.

We all do very different things, and to be perfectly honest, most probably feel their job is the "hardest," but in the long run, we all do very hard work and we all have a vital role in the workings of the hospital. Depends on what you are looking to portray. Difficulty can strike any case in any specialty, but the areas where things can go south in a hurry include trauma, transplant, vascular, cardiac (off the top of my head). Throw in something involving a kid and the stakes (and stress) increases.

/nods

But realistically, most interns and junior residents in the OR are not doing the difficult or life-and-death cases. If they are, there are four other people scrubbed in ahead of them and they are not touching ANYTHING. If something critical happened, they are likely not going to be able to fix it either.

So it goes intern-junior-senior-chief-attending/staff. Is it conceivable for a 28 year old to be a senior? On the cusp of leading a team?

 

[smq123]

It doesn't have to be neurosurgery. I would almost prefer if it wasn't. I don't even have to explicitly state which field he's in. But, yeah, I'd say at large it's the 'brain' part of 'brain surgeon' that brings in the appeal.

If he's in the OR all day, is he observing/doing and washing in and out for surgeries all day?

Usually, they refer to that as "scrubbing" in for a surgery. I think that's a more accurate term, since that's really what you're doing - not just washing your arms and hands.

I agree with Castro - I think that heart surgery and trauma surgery are more dramatic. But the problem is is that your character, if he is 28, will not be old enough to be able to do exclusively heart surgery or exclusively trauma surgery. All surgery residents have to rotate between different teams - you might spend 6 weeks on the heart surgery team, and then switch and spend 6 weeks with the transplant surgery team, and then switch to spend 6 weeks with the plastic surgery team, etc.

If he were training in neurosurgery, then by age 28 he would be learning almost exclusively neurosurgery.

Is there any way to make your character a little bit older?

 

[smq123]

Something is going to happen that makes him need to get away.

In real life, emergencies will pop up. But, in that case, a responsible resident would probably have to immediately call/page his senior resident, explain the situation, and try to find another resident to temporarily take over his duties.

I'm just a med student, but I'm not allowed to just take off and not tell anyone, even in the case of an emergency - and I don't have any "real" clinical duties! You need to let someone know if you're not going to be able to show up one day.

So it goes intern-junior-senior-chief-attending/staff. Is it conceivable for a 28 year old to be a senior? On the cusp of leading a team?

At a big university-affiliated hospital, where they take care of very sick patients - this is unlikely. Unless he sped through high school and college, and graduated college when he was 19 or something.

 

[Castro Viejo]

When someone who's going to go down the surgery road is 22 and about done with the typical 120 credit thing... what is that person doing? I have a friend who is going to be a nurse. She's that age and just finished her clinicals and works at a hospital A LOT. What would my character be doing at this age? How often would he get to go out at that age? Is it conceivable to take a summer off after the four years and not do anything?

Typically a college graduate is 22 years of age and then enters medical school which is four years long. The average age for an entering medical student in the United States is 22-23. That one year between med school and college is anything from pursuing a graduate degree, time off for research in a lab, time off for travel (not typically), etc.

At 22 your character would be a first-year medical student. He'd be in the library almost all the time, studying his butt off unfortunately. Not terribly exciting.

Go out? Possibly once a week? I've known some classmates in med school to go out almost every other night, but they're a rarity.

Most med students, on graduation, will go directly into residency and not take time off. There are some who will during the course of the four years decide to take time off prior to graduation. But once you're in your final year of med school and you enter the residency selection process ("the match"), you're contractually bound to enter residency on July 1st of the year you graduate with your M.D.

This helps a lot. Would a junior/midlevel ever get one on one time with a patient?

With every admission he is bound to do during the course of the day and night.

Something is going to happen that makes him need to get away.

Then he will arrange with his fellow Senior or Chief Resident to cover him for the week before he leaves. If he's an upstanding guy and a stellar resident, he's not going to abandon the hospital and take off.

So it goes intern-junior-senior-chief-attending/staff. Is it conceivable for a 28 year old to be a senior? On the cusp of leading a team?

Yes, that's the hierarchy in surgery. If he skipped a few grades, entered med school at 20, he'd be a fourth-year resident by 28.

 

[Bitsy3221]

When someone who's going to go down the surgery road is 22 and about done with the typical 120 credit thing... what is that person doing? I have a friend who is going to be a nurse. She's that age and just finished her clinicals and works at a hospital A LOT. What would my character be doing at this age? How often would he get to go out at that age? Is it conceivable to take a summer off after the four years and not do anything?

In this day and age, there are 1001 paths to get to medical school, but it is the great minority who have previous training as a nurse or other health care professional. The "traditional" route is to go to undergrad and major in some sort of science (biology, chem, biochem, neuroscience, etc.), apply during the senior year and (hopefully) start med school in the fall after graduating. Certainly, there is the chance to take time off--a lot of people HAD to take time off if they didn't get into medical school on their first application. In that time, a science degree doesn't give you a lot of employability--you can not work as a nurse unless you have some sort of nursing degree. Even though I have seen it portrayed in the media before, very, very few people choose to become a nurse to "work their way" through medical school.

I suppose it's possible for a 28 year old to be a more senior resident, but then you are getting into the graduating early from high school and/or college and your risk drawing the Doogie Howser comparisons. (For a show that's been off the air for 15 years, I still hear about it all the time and has forever branded young and young-appearing physicians!)

 

[Winged Scapula]

Age: although Castro notes above that the average age of a medical school grad is 26 or 27, that is not exactly true. It is true that if you MC graduated from HS at age 18, finished college in 4 years and then went straight into medical school, he could be 26 or 27 as an intern. Many people however, take time off, need to bolster their application, etc. or change their mind about what to do, so the average age is actually older (which accounts for 40 year old and up second career doctors).

At any rate, unless your MC was some sort of genius it would be unlikely that at age 28 he was anywhere near the Chief level in a surgical specialty, especially Neurosurgery. Most Chiefs would be in their early to mid 30s.

Spending time with Patients: as a junior resident, he would spend most of his time with patients, at least in more traditional programs where the junior residents are doing chores outside of the operating room (admitting and discharging patients, checking up on their labs and wounds during the day, etc.). Depending on the day and the specialty, your MC would spend more or less time with patients. Remember many neurosurgery patients are very sick and he's not likely to have any productive conversations with them.

Putting oneself through school: As noted above, there is no free time, at least not in the final two years of medical school, to work enough to pay for tuition and living expenses. Most medical students take out student loans. $200K would not be an unreasonable loan amount and I might push that to $300K if he's attending an Ivy League or other private medical school.

Medical Students: your friend who is training to be a nurse has a totally different schedule than medical students and pre-med students. In general medical students might take time off before starting medical school (see above) or the summer after first year, but they don't do any in hospital rotations while in undergrad, like your nursing friend. The final two years of medical school are spent in the hospital; the first two years in lectures.

PS: The part about naming the character Dr. Cox is an SDN joke relevant to me since that is my last name (see my sig below).

 

[Blade28]

I was going to ask if you were talking about Blade or Castro, but I guess I got my answer, gendered pronouns aside...

P)

Hey that describes me perfectly!

40 hours/week throughout all of undergrad, massive loans for med school...

 

[Anka]

I worked throughout med school (averaged about 20 hours per week, lots of variablity depending on rotation). Made enough to cover living expenses, and still did well in school. So, it's possible, but definitly not common. I was the only one and people thought I was nuts.

Anka

 

[Winged Scapula]

I worked throughout med school (averaged about 20 hours per week, lots of variablity depending on rotation). Made enough to cover living expenses, and still did well in school. So, it's possible, but definitly not common. I was the only one and people thought I was nuts.

Anka

There are a lot of misconceptions out there and the guy working and putting himself through med school is one of them, which is why we don't want to encourage the OP to highlight that. IMHO, its very rare, especially during the final two years and if anything were to come of his screenplay, I'd rather he show that most students take out massive amounts of loans...something that the lay public definitely doesn't know.

But congrats on doing it yourself.

 

[Anka]

I'm planning on him being in the neurosurgery line. Unless there's some sort of jack of all trades field. Anyways, in a surgery, how often does an artery get accidentally snipped? Is that too cliched of a Hollywood device for botches in a surgery? What SHOULD an accident be, if there is one? And if there is one... what would happen to this guy? When the main surgeon looks over it to assess the damage, would the guy get to continue or would he get taken off? Is it case by case?

Any help on this would be greatly, greatly appreciated.

I think the mistake we all fear is wrong site/wrong person surgery. I'm sure you can imagine the tension that develops in the room when, for instance, you know the patient you were supposed to be operating on had his aortic valve replaced in the past, but when you open the aorta you find a native valve; or if the imaging in a neurosurgery case is hung the wrong way, and the wrong side of the brain is trashed looking for a tumor that is really on the other side. There are protocols in place at every hospital to keep this from happening (called a "time out for safety" or "time out"), but you can imagine a brash surgery resident overriding the nurse who called time out. The nurse is suposed to stand her ground and not hand the surgeon a knife until the time out has been performed, but you can imagine a nurse right out of school, maybe afraid of the big bad neurosurgery resident, handing the knife to him. This is actually pretty darn rare, we all take the time out very seriously.

Another big problem is getting into veins. There is a little saying I was taught "blue blood from the back is bad", referring to venous blood inexorably welling up after an IVC or hepatic vein injury; you can't find the injury because the blood is decreasing visualization, and unlike arteries, veins don't really spurt or anything to draw your eyes to the hole. Imagine the patient's entire blood volume going to a suction canister, while the surgeon is yelling "I need exposure! Get the blood out of the field! Your sucking sucks. It just really sucks. I don't know what else to tell you but I can't f**king sew with all this blood in my face!!!" and so on.

A patient could start to wake up while on cardiopulmonary bypass and tear out a cannula; or the resident could not secure it correctly and have it just come out during the case... that would result in blood hitting the ceiling pretty dramatically. Whoever the hero is going to be would scrub in rapidly while shouting orders to the person running the heart-lung machine, recannulate the patient, and save the day.

The problem with neurosurgery is that problems don't go well -- once the brain is damaged that's kind of it. You might go over to www.uncleharvey.com where they have forums, to talk to neurosurgery residents.

As far as what happens afterwards, it depends on the attending and the resident. Usually the attending takes the resident to task, and after a big mistake, the resident is usually pretty shaken although some have greater intestinal fortitude than others. Something like wrong site/wrong person surgery where you overrode a nurse trying to do a time out will get you lynched. Technical errors get you in trouble, but not nearly the kind of trouble you get into for something like failed timeout. If things go well after a technical problem, the resident is often allowed to continue the case once the danger has passed.

 

[Winged Scapula]

We also have neurosurgery forums here at SDN.

 

[BlondeDocteur]

Darnell, thanks SO much for asking questions on this board. Lots of us secretly like the medical TV shows, but the actual medical stuff is so implausible that it results in a lot of head-smacking, which does detract from the viewing enjoyment.

To get on the same page--your guy is 28, from a middle/working class background, a surgery resident of some kind, arrogant but smart and talented, and a graduate of an Ivy med school in an "Ivy" hospital. Drama happens and he needs to abandon ship for a couple of days to clear his head.

Make him graduate from med school at 24, so he'll have finished college at 20. He'll be two years ahead of where he should, a senior (4th yr) resident in surgery at 28, and that's not all that implausible. Say he went to State U and tore up all his classes in undergrad, graduating early and smoking the MCAT to get into a great med school. He continued his meteoric rise, aced the Boards, graduating AOA (the top medical academic honor) and got his first pick surgery residency at the very prestigious ivy-encrusted XYZ Hospital. All totally realistic.

And now he's a senior resident at XYZ. It's his first year where he truly gets to "drive the bus" in the OR and man, he loves it. He's got great technical skill and he lets everyone know it. Things he would be doing day-to-day:
-- running rounds in the AM with the medical students and the lower-year residents/interns
-- approving the patient care plans of the intern/student/junior residents.
-- scrubbing in on any case he wishes on his service. (N.b. surgery in hospitals is divided up-- there's one service that only does colorectal cases and takes care of those patients; one cardiac service; one transplant service; one vascular; etc). He gets the "big whacks," and often he'll be the operating surgeon. The attending surgeon-- the boss, who's a grown up and finished residency and everything-- will take the assistant's position and tell him what to do, but his hands are doing it.

All a great setup for some major drama. Something bad happens in the OR, undermining that fantastic confidence of his... and he has to take off for parts unknown.

Here's what NOT to have your guy do. The following items would cause head-smacking amongst the medical community.
-- the attending surgeon, for whatever reason-- sick kid, collapses from a heart attack in the OR, whatever-- can't make it. Our guy soldiers on and operates alone, without supervision.
-- our guy tells his boss exactly what kind of operation the patient needs and how it's done
-- our guy tries to do a type of surgery in which he has less than zero training. A great example is brain surgery-- unless he's a neurosurgery resident, he will not be glimpsing a human brain anywhere except in the path lab. Likewise heart-- it takes like 6 months just to learn how to put someone on bypass. No 4th year resident will be *doing* cardiac stuff.
-- our guy encounters an incredibly mundane problem (like snipping an artery) and is the only person who can fix it, which he does as his boss watches, stupefied.
-- our guy tosses around fancy-sounding anatomy terms that are completely implausible (personal pet peeve).
-- making him bouncy, chipper and full of energy. He will be exhausted.
-- showing him outside the hospital during daylight hours.

 

[Anka]

The hospital you set it at will have an effect on the 'feel' of the whole thing. The "clinics" [Mayo and Cleveland] tend to be pretty gentlemanly. The big east coast schools tend to be more formal, have a stronger heirarchy, and have a bit more of an 'edge' to them as far as interpersonal interactions.

Anka

 

[DarnellWeeks]

I wish to right now give a personal thanks to every single one of you who have posted in this thread. Every single post has helped. Seriously. If I had the time to respond to each post I would. When I'm not balls deep in this project I will try. I cannot stress how thankful I am to you all here.

I had one quick question for ya'll before I get back to writing, as I want to start this plot thread before Thursday and really can't fathom stopping writing until then: What happens when a senior resident and the attending disagree on a diagnosis/what procedure to do? What would happen if the SR were to speak independently to the patient or if the patient was a child its guardian and voice his concerns?

 

[jubb]

Usually the resident just does what the attending wants and then the resident gets reamed at the weekly Morbiditiy and Mortality conference, where they review all the bad outcomes for the week, as if he alone made the decision.

 

[Winged Scapula]

Disagreements are pretty uncommon and are not handled lightly or welcomed.

If a resident thinks the attending is doing something dangerous, they will usually try and get out of doing the case or covering that patient, perhaps complaining to the program director. A resident may present the attending with literature or data to support his preferred plan and the attending may or may not go with that alternative. But outright disagreements? Attending almost always wins and the resident gets blamed for it, if something goes wrong.

Surgery is very hierarchical and that's why most of these tv shows and movies about surgery are inaccurate. Surgery residents, even Chiefs, generally do not publically disagree with their superiors. It would like an enlisted man arguing with an officer; grounds for dismissal.

 

[Blade28]

Disagreements are pretty uncommon and are not handled lightly or welcomed.

If a resident thinks the attending is doing something dangerous, they will usually try and get out of doing the case or covering that patient, perhaps complaining to the program director. A resident may present the attending with literature or data to support his preferred plan and the attending may or may not go with that alternative. But outright disagreements? Attending almost always wins and the resident gets blamed for it, if something goes wrong.

Surgery is very hierarchical and that's why most of these tv shows and movies about surgery are inaccurate. Surgery residents, even Chiefs, generally do not publically disagree with their superiors. It would like an enlisted man arguing with an officer; grounds for dismissal.

Agree with the above.

The military is really the best analogy of how the surgical residency hierarchy functions. Superiors are allowed to verbally abuse their juniors, and you always work your way up the chain of command whenever there's a dispute/problem/conflict. Suffering through a General Surgery residency helps you and your coresidents bond, just like soldiers who go through boot camp together.

It's tough for me to think of any other professions where daily verbal abuse is not only tolerated, but expected and assumed.

 

[SocialistMD]

The military is really the best analogy of how the surgical residency hierarchy functions. Superiors are allowed to verbally abuse their juniors, and you always work your way up the chain of command whenever there's a dispute/problem/conflict. Suffering through a General Surgery residency helps you and your coresidents bond, just like soldiers who go through boot camp together.

It's tough for me to think of any other professions where daily verbal abuse is not only tolerated, but expected and assumed.

I was thinking about this the other day. I think it is because surgery was really founded in the military, so the approach is the same.

 

[Castro Viejo]

I was thinking about this the other day. I think it is because surgery was really founded in the military, so the approach is the same.

Was it? I know trauma and its varying principles of treatment were sort of founded and refined through several major wars, but not surgery in general. I think the surgical hierarchy probably comes from Halsted and his model for the surgical residency in terms of "graduated responsibility." When you equip someone with knowledge over a junior, he can be a very dangerous and domineering type. Just ask any Chief Resident.

 

[DarnellWeeks]

How pissed off would an attending be if a Senior Resident went straight to a patient and said: the surgery you're going to have is wrong. You need this surgery. And then patient refused to sign the consent form for the surgery the attending wanted and would only do the one the senior recommended? How big of an asschewing? Some form of discipline?

How old is the average attending?

Also:

What's a realistic case for two surgeons--not necessarily neurosurgeons--to disagree on? I'm not going to be going into a 'House' like approach where they argue back and forth about this and yappity yap yap yap. I'm just curious about examples about what a disagreement like this could be on. For example... some guy thinks it's, I don't know, the plague, and the other thinks it's scurvy. I'm obviously NOT GOING TO BE USING THAT AS AN EXAMPLE, but seeing as how I'm completely ignorant to 99 percent of the ongoings of a surgeon I do need examples of potentially dangerous misdiagnoses and the more obscure--hell, doesn't even have to be obscure--right diagnoses. If that makes sense. I know I'm rambling.

 

[chrisisinnocent]

How pissed off would an attending be if a Senior Resident went straight to a patient and said: the surgery you're going to have is wrong. You need this surgery. And then patient refused to sign the consent form for the surgery the attending wanted and would only do the one the senior recommended? How big of an asschewing? Some form of discipline?

It would be a pretty big breach of the chain of command. Would definitely result in a huge asschewing. As far as discipline goes it depends on the program. The most likely result would be a bad eval at the end of the rotation.

How old is the average attending?

40-60 is generally what I have seen. Most are late 40s to mid 50s.

Also:

What's a realistic case for two surgeons--not necessarily neurosurgeons--to disagree on? I'm not going to be going into a 'House' like approach where they argue back and forth about this and yappity yap yap yap. I'm just curious about examples about what a disagreement like this could be on. For example... some guy thinks it's, I don't know, the plague, and the other thinks it's scurvy. I'm obviously NOT GOING TO BE USING THAT AS AN EXAMPLE, but seeing as how I'm completely ignorant to 99 percent of the ongoings of a surgeon I do need examples of potentially dangerous misdiagnoses and the more obscure--hell, doesn't even have to be obscure--right diagnoses. If that makes sense. I know I'm rambling.

Not that realistic. Most patients are assigned to one attending that manages their care (generally whoever was on call the day they were admitted). I have seen attendings disagree on decisions but they generally stay out of each others' business.

 

[Danbo1957]

Senior Residents in all divisions of medicine are pretty much "developed by the system" in which he/she learns - and should be on the same page as his "superiors". Going against a decision from one who taught you means one of two things, your superior IS wrong, or you are.

Think about that for a while...

The House style of diagnostics is used by many, but House's Fellows are really good doctors with experience (attendings themselves).

 

[DarnellWeeks]

Senior Residents in all divisions of medicine are pretty much "developed by the system" in which he/she learns - and should be on the same page as his "superiors". Going against a decision from one who taught you means one of two things, your superior IS wrong, or you are.

Think about that for a while...

I have. And for someone who isn't just arrogant but actually believes he's always right and actually cares about the patient in this case is making him do this choice.[/quote]

 

[dienekes88]

Senior Residents in all divisions of medicine are pretty much "developed by the system" in which he/she learns - and should be on the same page as his "superiors". Going against a decision from one who taught you means one of two things, your superior IS wrong, or you are.

Think about that for a while...

The House style of diagnostics is used by many, but House's Fellows are really good doctors with experience (attendings themselves).

Funny you should mention House, because almost this exact scenario happened on the show.

*spoiler alert*

Season 4 Episode 7 - Ugly. At some point during the show, House thinks it's Juvenile Rheumatoid Arthritis, but Taub - one of the fellows and a former plastic surgeon - doesn't think it is and lets the father know as much. As a result, House fires him, but Cuddy intervenes saying that nobody is going to be fired in the middle of a case. It's quite a bit more complicated than that with the clashing of personalities and the development of Taub's character (he's relatively new to the show).

Edit: Oh yeah, part of the issue is that Taub really connects with the patient, because the patient has a major deformity. Taub talks about plastic surgeons seeing what a person "can be" while everyone else sees a person as he is.

 

[Danbo1957]

... And for someone who isn't just arrogant but actually believes he's always right and actually cares about the patient in this case is making him do this choice.

If he acts upon his choice, he will be fired, he could be sued, and he could be charged criminally...

 

[smq123]

How pissed off would an attending be if a Senior Resident went straight to a patient and said: the surgery you're going to have is wrong. You need this surgery. And then patient refused to sign the consent form for the surgery the attending wanted and would only do the one the senior recommended? How big of an asschewing? Some form of discipline?

"Pissed off" might be something of an understatement.

Try "furious". Or "too angry to see straight".

What's a realistic case for two surgeons--not necessarily neurosurgeons--to disagree on? I'm not going to be going into a 'House' like approach where they argue back and forth about this and yappity yap yap yap. I'm just curious about examples about what a disagreement like this could be on. For example... some guy thinks it's, I don't know, the plague, and the other thinks it's scurvy. I'm obviously NOT GOING TO BE USING THAT AS AN EXAMPLE, but seeing as how I'm completely ignorant to 99 percent of the ongoings of a surgeon I do need examples of potentially dangerous misdiagnoses and the more obscure--hell, doesn't even have to be obscure--right diagnoses. If that makes sense.

Well, surgeons might disagree as to whether or not a tumor is operable or not. Surgeon A might think that the tumor is too close to a major blood vessel, and trying to cut it out would be too dangerous. Surgeon B might argue that the tumor can still be separated from that area without harming that blood vessel.

Or Surgeon A might feel that the tumor is too large to realistically cut out. Surgeon B might disagree.

(And in case you're wondering - a resident, even a chief resident - would not be involved in such a debate. It would be a debate between two attending surgeons. If the attending decides to operate, then the resident will do so - regardless of his personal opinion of the patient's prognosis.)

 

[kate0834tkjn]

What's a realistic case for two surgeons--not necessarily neurosurgeons--to disagree on? I'm not going to be going into a 'House' like approach where they argue back and forth about this and yappity yap yap yap. I'm just curious about examples about what a disagreement like this could be on. For example... some guy thinks it's, I don't know, the plague, and the other thinks it's scurvy. I'm obviously NOT GOING TO BE USING THAT AS AN EXAMPLE, but seeing as how I'm completely ignorant to 99 percent of the ongoings of a surgeon I do need examples of potentially dangerous misdiagnoses and the more obscure--hell, doesn't even have to be obscure--right diagnoses. If that makes sense. I know I'm rambling.

This is probably not a great example, but I was on a surgery team with 2 attendings, a senior resident, a junior resident, and an intern. My second week of surgery, one of the attendings went on vacation, leaving the one patient she had in the hospital for the other attending to take care of. The patient was a 55-ish year old lady who had a pretty large incisional hernia from a prior laparotomy. She also had metastatic colon cancer. The first attending (the one who went out of town) had repaired the hernia laparoscopically using a huge piece of mesh. When the second attending rounded on the patient, he pointed out that the first attending shouldn't have done it that way b/c 1) it's a longer surgery with more pain for the patient, in his experience, and 2) part of the reason to use mesh is so that the repair will last longer, but he didn't think this patient was going to live long anyhow, given her cancer. I believe his exact words to us (me and the 3 residents) were, "Dr.____ doesn't know what the f**k she's doing, don't you EVER do something like this. Now we're going to have to round on this b***h all weekend and listen to her moan and groan." Ah, how I miss my surgery attendings......

Anyway, that's definitely not a sexy, dramatic example, nor is it probably a matter of life or death, but it was one "real" example from my general surgery rotation. The attending I reported was also kind of insane, so perhaps (hopefully?) this situation wouldn't arise commonly (as in one attending questioning another in front of students/residents).

Good luck w/ your screenplay! Oh, and I definitely agree that portraying surgeons in a more positive light is a great call! As you can probably guess from my description above, I had flat out mean, nasty, yelling, throwing attendings.....break the mold!!!!

 

[Blade28]

Was it? I know trauma and its varying principles of treatment were sort of founded and refined through several major wars, but not surgery in general. I think the surgical hierarchy probably comes from Halsted and his model for the surgical residency in terms of "graduated responsibility." When you equip someone with knowledge over a junior, he can be a very dangerous and domineering type. Just ask any Chief Resident.

I think its origins also have to do with its beginnings as an apprenticeship-model, similar to many other guilds - compare to the blacksmith, carpenter, etc. of the medieval era.

 

[DrDre311]

Regardless of the origins of the surgical hierarchy, I think the military analogy is certainly the most appropriate. It's sort of a mix of military rigidity and fraternity-style hazing (although the hazing to which I refer does not involve alcohol or breaking into sorority houses).

In our culture it is NOT OK to disagree publicly with your superiors, and I personally would have to be damn certain that my patient was going to suffer a very bad outcome to voice any disagreement to anyone besides my dog. It definitely couldn't be over anything trivial like the use of mesh in a hernia repair.

 

[Winged Scapula]

In most medical/surgical circles, it is considered COMPLETELY inappropriate for any member of the health care team to question the attending's decisions in front of the patient. We often have this problem - sometimes its nursing ignorance (ie, they don't really understand what we do, get confused and tell the patient the wrong thing) and sometimes its a willful act against the surgical team.

While the hierarchical nature of surgery certainly plays a role here, more importantly is the faith that a patient has in her surgeon. Once that has been destroyed, its very hard to get back. Thus, any member of the team who questions or contradicts the primary surgeon in front of the patient and/or their family, must be talked to and reprimanded if necessary.

It would not be unrealistic in the situation you describe (resident who sneaks around behind attending's back and tells patient something totally diferent), to see the resident be fired, or put on probation at the very least. It is a serious misstep.

As noted above, most attendings don't get into each other's business. Of course, if something goes wrong, at the weekly M&M conference everyone will make it their business, but you generally don't see two attendings arguing about something.

 

[DarnellWeeks]

If he acts upon his choice, he will be fired, he could be sued, and he could be charged criminally...

Charged criminally for giving a patient a second opinion? Really? Like, really? And sued?

That does it. I'm moving to Cuba.

 

[DrDre311]

You can get sued for pretty much anything. Part of the fun of being a doc--gotta love med-mal lawyers.

 

[Winged Scapula]

Charged criminally for giving a patient a second opinion? Really? Like, really? And sued?

That does it. I'm moving to Cuba.

Danbo meant that he could be charged criminally for acting on his choice, not for giving the patient a "second opinion" (which in this case is not apropos - a second opinion comes from someone not involved in the primary care of the patient).

So if a resident overruled the attending and took the patient to the operating room with the attending's approval (which you don't see anymore anyway), yes he could be charged with abuse, which is a felony. There have been plenty of cases in which patients underwent procedures they felt they were not adequately informed about or were unable to be so (ie, in the case of intellectual challenges) and the physician is charged with physical abuse.

 

[maxheadroom]

Seriously, don't show people showing up the the hospital when it's sunny outside. Seriously.

And no one sits around the house getting ready to go to work, making breakfast/having coffee while they get all prettied up before a day of surgery. It's more like roll out of bed, hit the shower, quick shave, and roll out of the house with breakfast bar and Diet Coke in hand.

 

[Castro Viejo]

I think its origins also have to do with its beginnings as an apprenticeship-model, similar to many other guilds - compare to the blacksmith, carpenter, etc. of the medieval era.

Yeah... At one point in ancient history weren't people getting laparotomies and a haircut from the same guy?

 

[Castro Viejo]

That does it. I'm moving to Cuba.

Uhm... Not because of that pile of trash and anti-American propaganda that Michael Moore produced, right?

Health care, by and large, is NOT better in Cuba compared to the United States. Don't let that fat idiot tell you any different.

 

[Blade28]

Yeah... At one point in ancient history weren't people getting laparotomies and a haircut from the same guy?

Yup. Guilds of "surgeons and barbers." That's why barbershops have that red/blue swirly thing outside - the red and blue symbolizes blood and blood vessels, while the white symbolizes the sheet/drape.

 

[Runtita]

This is more of an illustration on the mindset of a surgery resident:

I was a 3rd year student doing my surgery rotation. After the procedure, my team was standing around in the PACU dictation area (post-anesthesia care unit) while our attending dictated the procedure note. I was hungry; it was probably around 2 pm and we had worked through lunch on a lengthy vascular procedure. I pulled out a granola bar from the pocket of my white coat and proceded to munch down. At that point, the 2nd-year surgical resident turned to me and seriously said (I **** you not!), "Never eat before your attending does."

F that!

 

[DarnellWeeks]

Uhm... Not because of that pile of trash and anti-American propaganda that Michael Moore produced, right?

Health care, by and large, is NOT better in Cuba compared to the United States. Don't let that fat idiot tell you any different.

I guess I forgot my sarcasm tags. I just find it mind boggling that a resident can be sued for disagreeing with an attending.

 

[Castro Viejo]

Yup. Guilds of "surgeons and barbers." That's why barbershops have that red/blue swirly thing outside - the red and blue symbolizes blood and blood vessels, while the white symbolizes the sheet/drape.

 

[Winged Scapula]

its not disagreeing with the attending that gets the resident sued. rather taking action (ie, performing a different surgery than what the patient was consented for) that is the problem. The former may get you fired, the latter fired and sued.

 

[Castro Viejo]

I just find it mind boggling that a resident can be sued for disagreeing with an attending.

I'm not so sure about that. The resident is a student/trainee for all intents and purposes. If an attending/faculty/staff member doesn't like him or her, he or she can simply push to have the resident terminated or held back. I've never heard of even one instance of a resident being sued by his or her attending for a disagreement..